Meow…

1/3 On July 20, 2014, a seriously ill man arrived in Lagos, Nigeria, on a flight from Liberia. His name was Patrick Sawyer. He had a fever, vomiting, and diarrhea. He was taken to First Consultants Medical Centre, where doctors initially treated him for malaria. But one physician recognized a far more dangerous possibility. Her name was Dr. Ameyo Stella Adadevoh. Ebola was spreading through West Africa. Nigeria had never recorded a case, and Lagos was a densely populated international transportation hub. Adadevoh considered the patient’s symptoms and recent travel history. She suspected Ebola and insisted that he remain isolated while testing was arranged. Sawyer wanted to leave. According to the hospital’s director, the Liberian ambassador also pressed for his release, arguing that the hospital was unlawfully detaining him. Sawyer had traveled to Nigeria for an important regional meeting. Adadevoh and her colleagues refused. Imagine the circumstances. An unfamiliar disease was devastating neighboring countries. The patient was demanding his freedom. Diplomatic pressure was mounting. The diagnosis had not yet been confirmed. She understood what releasing a potentially infectious patient into Lagos might mean. The hospital maintained his isolation, and public-health authorities were alerted. On July 25, Sawyer died. Laboratory testing confirmed Ebola. By then, the physician who had helped prevent his departure had herself been exposed to the danger.

1/3 In February 2003, an Italian physician working for the World Health Organization in Hanoi was called to investigate a patient suffering from an unusual and severe pneumonia. His name was Dr. Carlo Urbani. He was 46 years old, a specialist in infectious and tropical diseases, and a former president of Médecins Sans Frontières Italy. What he encountered in that Hanoi hospital would become one of the defining moments in the history of emerging infectious diseases. The patient was gravely ill. Soon, doctors and nurses caring for him began developing similar symptoms. Urbani recognized that something dangerous was unfolding. He alerted the WHO and worked with Vietnamese authorities and hospital staff to introduce isolation procedures, protective measures, and infection controls. Nobody yet fully understood the pathogen they were confronting. The disease would soon become known worldwide as Severe Acute Respiratory Syndrome — SARS. Urbani’s early recognition and insistence on immediate action helped give Vietnam a crucial advantage in containing the outbreak. But while trying to prevent the disease from spreading, he had almost certainly been exposed himself.

1/3 In February 2003, an Italian physician working for the World Health Organization in Hanoi was called to investigate a patient suffering from an unusual and severe pneumonia. His name was Dr. Carlo Urbani. He was 46 years old, a specialist in infectious and tropical diseases, and a former president of Médecins Sans Frontières Italy. What he encountered in that Hanoi hospital would become one of the defining moments in the history of emerging infectious diseases. The patient was gravely ill. Soon, doctors and nurses caring for him began developing similar symptoms. Urbani recognized that something dangerous was unfolding. He alerted the WHO and worked with Vietnamese authorities and hospital staff to introduce isolation procedures, protective measures, and infection controls. Nobody yet fully understood the pathogen they were confronting. The disease would soon become known worldwide as Severe Acute Respiratory Syndrome — SARS. Urbani’s early recognition and insistence on immediate action helped give Vietnam a crucial advantage in containing the outbreak. But while trying to prevent the disease from spreading, he had almost certainly been exposed himself.

Shinjuku, Tokyo, Japan

8/ There remains a difficult limitation. MMR vaccination is not recommended for infants younger than 6 months. Their protection depends heavily on preventing exposure, including maintaining high vaccination coverage among the people around them. If a young infant is exposed to measles, urgent medical assessment is essential. For infants under 6 months, immune globulin administered within 6 days of exposure may reduce the risk of disease or modify its severity. That is post-exposure protection, not a substitute for routine vaccination.

6/ This is not a new concept. In countries with substantial ongoing measles transmission, WHO generally recommends the first routine measles vaccine at 9 months, followed by another dose later in childhood. During outbreaks or in other high-risk circumstances, WHO recommends an additional dose beginning at 6 months. That early vaccination is designated “MCV0” — dose zero — because the child must still complete the routine series. The strategy accepts a less robust early immune response in exchange for protection during a period when the risk of exposure may be unusually high.

3/ Babies receive measles antibodies from their mothers through the placenta during pregnancy. But this protection is temporary, and it doesn’t necessarily last until their first birthday. Research has shown that maternal measles antibodies can decline substantially within the first several months of life. The timing varies, including according to whether maternal immunity arose from vaccination or natural infection. That creates a window of susceptibility: an infant may have lost meaningful maternal protection without yet having received a measles vaccine. This is the vulnerability Hotez wants us to confront.

Dr. Peter Hotez has raised an important question about America’s measles resurgence. What happens to infants who are old enough to lose the protection they received from their mothers, but too young for routine measles vaccination? As of October 15, the CDC had recorded 4,410 U.S. measles cases in 2026, nearly twice the total reported during all of 2025. For babies between roughly 5 and 11 months of age, this raises an uncomfortable question: should we be offering measles vaccination earlier?

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Street Art - Tokyo